The Effectiveness of Motivational Interviewing on Glycemic Control for Adults with Type 2 Diabetes Mellitus (DM2): A Systematic Review

Abstract

Worldwide, 346 million people have diabetes. With the growing prevalence of diabetes, controlling modifiable risk factors is essential to preventing complications and disease progression. The prevalence of type 2 diabetes is estimated to be double the present rate and by the year 2034 nearly 44 million Americans will have this preventable disease. In the United States (US), nearly 13 percent of adults aged 20 years and older have diabetes; this includes 25.8 million people, adults and children . Type 2 diabetes is more common in ethnic groups inclusive of African Americans, Latinos, Native Americans, and Asian Americans, Native Hawaiians and other Pacific Islanders. Diabetes is especially common in the elderly, 10.9 million or 26.9% of those aged 65 years and older have the disease. The US Centers for Disease Control and Prevention (CDC) estimates that 26% of US adults have impaired fasting glucose (IFG) of 100-125mg/dl and that 34% of adults meet the criteria for metabolic syndrome. An additional 35 % of adults have pre-diabetes, a condition marked by elevated blood sugar that is not yet in the diabetic range.Type 2 diabetes occurs when people have insulin resistance and insulin cannot be appropriately utilized for blood sugar regulation. Type 2 diabetes is characterised by impaired glucose tolerance. It can be defined by the criteria derived from the World Health Organization [WHO] that uses a single fasting glucose value of ≥ 126mg/dl or a single two hour glucose value of ≥ 200mg/dl. A laboratory blood test examining levels of glycosylated haemoglobin (HgbA1c) provides an estimated average blood glucose level over the past two-three months. An HbA1C level of 6.5% or higher can indicate diabetes.Serious complications and premature death can ensue if type 2 diabetes is not treated. Collaboratively, the health care team and people with type 2 diabetes aim to manage this disease process, and lessen the risk of complications to the heart, blood vessels, nerves, eyes and kidneys. Comprehensive support, knowledge, multidisciplinary therapy and treatment modalities will enhance health outcomes and slow disease progression.The Healthy People 2020 initiative outlines several objectives to achieve these changes and cover a comprehensive assortment of disease specific management accountabilities including regular medical care and self-management education/training. Many behaviour change techniques and strategies are known to be successful, yet are seldom implemented in today's health care arena. Dieticians, diabetes educators, and nurse practitioners are in an excellent position to serve as change agents to assist patients with diabetes in making necessary lifestyle changes.Motivational interviewing (MI) is a well-known, scientifically tested method of counseling clients first described by Miller and further developed by Miller and Rollnick. Motivational interviewing is a useful intervention strategy in the treatment of lifestyle problems and diseases such as diabetes . MI is a client-oriented, directive method for enhanc...

Effect of motivational interviewing intervention on HgbA1C and depression in people with type 2 diabetes mellitus (systematic review and meta-analysis)

“…The impact of Motivational interviewing (MI) for T2DM patients [ 18 ] delivered by general physicians, Comparison of Motivational Interviewing (MI) effect delivered in different medical care settings [ 19 ], identify effective interventions for decreasing diabetes distress [ 20 ]. Motivational interviewing (MI) in the management of glycemic condition [ 21 ]. The effectiveness of Motivational Interviewing (MI) on blood glucose control among people with T2DM [ 22 ], impact of Motivational Interviewing (MI) on self-care practices among clients with insulin dependent diabetes mellitus [ 23 ], behavioral and drug related interventions for depression in patients with diabetes mellitus [ 24 ] and identifying psychosocial interventions that improve both physical and mental health in patients with diabetes [ 25 ].…”

Making sense of blood glucose data and self‐management in individuals with type 2 diabetes mellitus: A qualitative study

“…Motivational interviewing, an individualised counselling approach designed to elicit an individual's own motivation for behaviour change, has been used to promote behaviour change in adults with type 2 diabetes mellitus (Soderlund, 2018). Some researchers have noted improved dietary and physical activity (Ekong & Kavookjian, 2016;Swoboda, Miller, & Wills, 2016), and decreased blood glucose levels (Ekong & Kavookjian, 2016), but others found that the effects of motivational interviewing on glycaemic control were not significant (Concert, Burke, Eusebio, Slavin, & Shortridge‐Baggett, 2012). Empowerment‐focused interventions, that is education aligned with an individual's needs and experiences living with type 2 diabetes mellitus, have been found to be effective in improving adherence to diet recommendations and blood glucose self‐monitoring with subsequently lower HbA1C levels for up to 80% of study participants; however, such improvements decrease over time (Cheng et al., 2018;Ebrahimi, Sadeghi, Amanpour, & Vahedi, 2016).…”

Premixed vs basal-bolus insulin regimen in Type 2 diabetes: comparison of clinical outcomes from randomized controlled trials and real-world data

“…It is tempting to speculate that any discrepancies between real-world and RCT data are caused by fear of hypoglycaemia (especially among people on a basal-bolus insulin regimen [26]), weight gain [27], reduced adherence to a basal-bolus insulin regimen or patients' ambivalent attitudes to uptitrating insulin doses in real-world conditions because of lack of monitoring, patient education or rigid guidelines or protocols for patients to follow [28]. Fear of hypoglycaemia in real-world settings, for example, may explain the less apparent association between baseline HbA 1c and response to treatment in the real-world compared with the RCT population for both insulin regimens.…”

“…This may be attributed to a number of confounding factors, such as poor study quality, small treatment groups, short study duration and different study designs. Lastly, we pooled trials and real-world data using regular and analogue insulin because previous meta-analysis suggests similar HbA 1c outcomes between the two types [28]. Despite these limitations, it is important to note that the emphasis of the present study is a pragmatic approach to decision-making for initiation of insulin among patients who require insulin soon after diagnosis of diabetes in 'real-world' clinical practice based on variables that are available to clinicians, and to compare this with outcomes (glycaemic control and change in weight) derived from RCTs.…”